Mark Clemons, DMD
Individual provider Active NPI General Practice Dentistry · Galax, VA
NPI 1164517553 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164517553
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- VA0401005863 (VA)
- Practice address
- 301 W. Grayson St.
Galax, VA 24333-2813 - Phone
- (276) 236-6321
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VA0401005863 | VA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | VA0401005863 | VA | Yes |
Addresses
Primary practice location
301 W. Grayson St.
Galax, VA 24333-2813
Mailing address
301 W. Grayson St.
Galax, VA 24333-2813
Phone (276) 236-6321
Other providers in Galax, VA
- Chestnut Creek Counseling Center
- Chestnut Creek Orthopedics and Sports Medicine PLLC
- Kenneth A Clark
- John Paul Clay
- Clearchoice DME LLC
- Raymond Charles Clifford Sr.
- Dale Clymer
- Mary Kay Cole-Mitchell
- Charles Collins
- Jill Marie Combs
All providers in Galax, VA · General Practice Dentistry in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.